Measurement of fractional lipogenesis by mass isotopomer distribution analysis (MIDA) of fatty acids or cholesterol labeled from [(13)C]acetate assumes constant enrichment of lipogenic acetyl-CoA in all hepatocytes. This would not be the case if uptake and release of acetate by the liver resulted in transhepatic gradients of acetyl-CoA enrichment. Conscious dogs, prefitted with transhepatic catheters, were infused with glucose and [1, 2-(13)C(2)]acetate. Stable concentrations and enrichments of acetate were measured in artery (17 microM, 36%), portal vein (61 microM, 5. 4%), and hepatic vein (17 microM, 1.0%) and were computed for mixed blood entering the liver (53 microM, 7.4%). We also measured balances of propionate and butyrate across gut and liver. All gut release of propionate and butyrate is taken up by the liver. The threefold decrease in acetate concentration and the sevenfold decrease in acetate enrichment across the liver strongly suggest that the enrichment of lipogenic acetyl-CoA decreases across the liver. Thus fractional hepatic lipogenesis measured in vivo by MIDA may be underestimated.
Objective: Breast carcinoma en cuirasse is an aggressive manifestation of breast cancer, and is most often seen as a local recurrence. It is the most common primary malignancy to metastasize to the skin and palliative care is often the only option. Methods: Retrospective review of the patient's chart was done. Results: Our patient is a 65 year old female with no significant past medical or surgical history, who presented with a 2 year history of an enlarging left breast mass and left axillary mass, to the point where she had pain with breathing and restriction of chest wall expansion. Work-up of her breast and axillary masses showed carcinoma en cuirasse. Given the advanced stage of her disease, the patient was offered palliative care, which she declined. Conclusions: Breast carcinoma en cuirasse is a rare manifestation of cutaneous metastases from breast cancer. While it is usually seen as a local recurrence, it can also be seen, as in our patient's case, as a natural progression of breast cancer that is difficult to treat. Our patient's case highlights the importance of early detection and treatment of breast cancer, as well as the surveillance for local recurrence.
Yellow fever vaccine (YFV) can have rare but severe adverse events, including YFV-associated neurologic disease (YEL-AND), YFV-associated viscerotropic disease (YEL-AVD), and anaphylaxis. Risks of YEL-AND and YEL-AVD increase with age. YEL-AND is characterized by encephalitis, meningitis, Guillain-Barré syndrome, or acute disseminated encephalomyelitis within 28 days after vaccination. Meningoencephalitis is the most common manifestation. Diagnosis can be aided by polymerase chain reaction testing of cerebrospinal fluid for YF virus or for antibodies specific to the YF virus. Most patients with YEL-AND recover without residual deficits. Treatment should be chosen based on the presenting syndrome, and a neurologic consultation is warranted.
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